Physician: U.S. Is ‘Playing Infectious Disease Roulette' With Ebola

Barbara Hollingsworth | October 21, 2014 | 5:38pm EDT
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In this Oct. 18, 2014 file photo, a burial team in protective gear bury the body of a woman suspected to have died from Ebola virus in Monrovia, Liberia.  (AP Photo/Abbas Dulleh)

( – American public health officials are playing “infectious disease roulette” by not imposing a complete travel ban on African countries in the throes of an Ebola epidemic, says Dr. William Miller, a physician and author of a book on infectious disease.

“In infectious disease, it’s always a numbers game. It’s just about numbers. It’s statistics. It’s cold-blooded numbers. The Ebola virus has no standards other than trying to find susceptible hosts. So letting people in from the outside is a form of roulette,” he told

“It was based on the presumption, which has turned out to be incorrect, that the United States’ [medical] system is uniquely well-prepared to handle epidemics of this kind. Now as it happens, the United States has the robust set of resources that will enable it to treat Ebola here in the U.S. in ways that it cannot be done in Africa.

“We’re finding that the system, at least as it was a couple of weeks ago, was under-prepared and unrehearsed. We’re not ready for prime time yet with Ebola. So we need to have a travel ban.”

A travel ban would give medical personnel throughout the U.S. much-needed time to prepare for a possible outbreak of Ebola here, he added.

On Tuesday, Department of Homeland Security Secretary Jeh Johnson announced “travel restrictions in the form of additional screening and protective measures at our ports of entry for travelers from the three West African Ebola-affected countries.”

But Miller says that merely screening incoming travelers is not sufficient to protect the American public from the disease that has already killed nearly 5,000 people worldwide, according to the World Health Organization (WHO).

“Unfortunately, for diseases with no cures, isolation and quarantine are the only measures that have ever worked in history and they are the only measures that are going to work today,” he told

“From the point of view of biology, I feel strongly about, the concept of enhanced screening that we’re being offered as a sense of concern from our government is the crudest form of theater. The issue is not about those patients who show symptoms. It’s latency.

“In all infectious diseases, there’s a latent period. You have the bug, you have the virus, and you don’t show symptoms. You can be a carrier and you’re not infecting anyone. You are infected, but you have no symptoms. You may never develop them. That’s characteristic of many latent infections,” he told

“But others, like Ebola, can go up to 21 days of latency. Then it can explode inside you according to its own terms and scope. That’s how viruses act. That’s how this virus in particular acts. So the latency period is what we need to be concerned with, and the screening that they’re doing has absolutely no way of uncovering latent infections.

“So every single one of them [people who come to the U.S. from an Ebola hot zone] is kind of a ticking time bomb of potential infectious disease. And it’s just a matter of roulette where we get the next one.”

Although the threat to individual Americans is currently very low, Miller pointed out that “this is an outlier epidemic. We have epidemics going on in this country right now that are not Ebola. Ebola right now is a tiny thing. We have Enterovirus D68 going on and that’s a totally different kind of epidemic.”

Seasonal influenza and West Nile virus epidemics occur “all the time,” he added. “But sometimes you have an outlier event that excludes 98 percent of all occurrences. That’s what we have with Ebola. Seventy percent mortality in Africa.”

“The problem with Ebola is that all viruses mutate. When you have an active epidemic going, you never know whether it has reached its final form or not until you’ve quelled it. So what can Ebola become? Who knows? What should we do? Everything we wish we would have done if it did turn out to be the worst thing. So you don’t look back with any regrets.”

Miller acknowledged that it is not possible to stop every infected person from entering the U.S.

“We can never close down the borders. Those people who say that there’ll be leakage, it’ll never be perfect, they’re correct,” he said. “But when you have a system such as ours, and it’s a numbers game, the fewer the numbers of people that are infected that get in, the better off we are as a nation.”

During the Black Plague, medieval Venice imposed a 40-day quarantine on ships coming into its port by “trial and error,” Miller pointed out. “They tried 30 days, and they found out that it didn’t work.”

“What did the Venetians do 700 years ago when faced with a disease for which there was no cure, and which could ravage a population quickly if it got out of control? They did the very hardest thing: They said we’re a nation trading state, but we’re going to stop vessels and take the economic consequences, because what happens to us as a society if it gets out of control?

“That’s the same standard we should have today. I’m not saying Ebola will get out of control in the United States. It’s much less important than seasonal flu at the moment. But its potential is what matters.

“It is particularly gruesome. It is particularly fatal. And therefore, our standard of care should be what would we wish we had done if this does get out of control and becomes a significant national issue? And we should act in strict accordance with that standard now, which is not the policy we’re following.”

What should public health officials be doing now to protect the American public from Ebola? asked Miller.

“We would interdict. We would not allow free travel of business passengers and vacationers from hot zones. And we do that while we rehearse here, while we actually get the CDC doing its job better than it has," he replied.

"Give our hospital systems time to organize in depth. And then in three weeks, five weeks, we can look again at what our state of preparedness is and make a decision whether or not to lift our travel restrictions, and we’ll base it on the course of the epidemic in Africa at the same time.”

A 2011 photo of Thomas Eric Duncan (right), a Liberian who became the first person to die from the Ebola virus in the U.S. (AP photo/courtesy of Wilmot Chayee)

He added that the government’s response to Thomas Eric Duncan’s death in Dallas and the subsequent infection of two nurses treating the Liberian man, who was the first person diagnosed with Ebola in the U.S., has left many people fearful.

“I talk to people all the time and I have to yet to hear someone say ‘I completely trust what the government is telling me.’ People are already concerned. There’s no generalized sense of panic. There’s simply deep mistrust that they’re being misled,” Miller told

“We all know we’re being patted on the head, and we resent it. Once you break trust with the American people, and they no longer have confidence that you’re telling them the truth, then you’re sowing the seeds for panic.”

“And when nurses in fully-protected garb become infected, it tells us that we really don’t understand what the hell we’re doing” with Ebola, he added.

All but five or six medical facilities in the country are capable of safely treating Ebola patients, he pointed out. “There’s no chance in the world that local community hospitals would know what they’re doing. Not for Ebola. That takes very specialized equipment, very specialized training. That’s why we dare not let it get out of control.”

“ And yet we have a group of policy makers that really are terrific people, the [Centers for Disease Control director] Tom Friedans and the [National Institutes of Health director Anthony] Faucis, these are wonderful women and men who want to do the best job they can. They are deeply caring. Their motivations are of the soundest kind. They simply have developed a form of tunnel vision.”

Although imposing travel restrictions would undoubtedly have unintended consequences, it is necessary to protect the health of the American public, Miller said.  “There is no necessary symmetry between stopping casual travel out and [letting humanitarian] aid in….like the Berlin airlift. It can be done.”

“This is biology in action,” he added.  “And what we’re getting now are government decisions that are a mixture of biology, economics, sociology, political currency, but on a biological basis there’s nothing to think about. You would stop the flow of infected people into the country by every means that you possibly can, accepting that it will be imperfect.”

Miller, now an independent researcher after practicing radiology for 30 years, is the author of The Microcosm Within: Evolution and Extinction in the Hologenome. “The text is all about the relationship of infectious disease across the spectrum of biology and how it interacts as the common currency of biological interactions in many ways that were ill-understood, which include evolution and extinction,” he explained to

“So infectious disease is the basis for what forms our experience on this planet. You are alive only because your immune system is capable of fending off an enormous array of pathogens that you don’t see.

“And in fact, the concept of hologenome, which is a new concept in medicine but is well recognized now, is you are not what you think you are. You are a constellation of life that is very complicated, and infectious disease dynamics decide whether you continue or not.”

Miller calculated that “the volume of microbial cells associated with us outnumbers our innate cells by a factor of 10 to 1. The amount of that microbial genetic material overwhelms our intrinsic cellular DNA by a factor of 100 to 1,” he said in a March interview.

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